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For many people, cravings are an important driver of weight struggles, and can present a significant obstacle to weight management success.

What are cravings exactly, and how can we address them in weight management?

As blogged in detail previously, there are three levels at which the brain controls appetite and eating behaviours:

  • homeostatic eating (eating for hunger)
  • hedonic eating (eating for the pleasurable effect of food)
  • executive function (the part of our brain that makes the decision to eat (or not))

The hedonic centers reside in the mesolimbic areas of our brain.  Dopamine is the neurotransmitter primarily involved in the wanting of food, and opioid and cannabinoid receptors are primarily involved in the liking of food.  Cravings actually represent a cycle of learned behavior, driven and reinforced by the hedonic system:   

  • The cycle starts with a genetically ingrained drive (stronger in some people than others) to consume high calorie foods (remember, evolution has built us to want to find and eat calorie dense food to survive famine); and/or, we are exposed to a calorie dense food in our environment (let’s say, your kid or friend suggests a stop at an ice cream shop or a fast food joint).
  • Eating this food makes us feel good (here is the dopamine and opioids kicking in – noting also highly variable genetically hard-wired brain response from person to person here).
  • We remember this pleasurable experience thanks to the skills of our mesolimbic pathways.
  • The next time we pass that ice cream shop or smell the delicious scents wafting out of the restaurant, or even just think about them, our dopamine fires up and boom! We find ourselves craving that food.

Food cravings make it harder to stick with healthier lifestyle choices, and managing cravings is a key component of a successful weight loss and maintenance program for anyone who struggles with cravings.

What tools do we have to help manage cravings?

It turns out that all Three Pillars of Weight Management (psychological support, medications, and bariatric surgery) have options that can reduce cravings, or improve our ability to resist them.

As per our Canadian Obesity Guidelines chapter on effective psychological interventions in weight management, behavioral interventions that strengthen restraint (self-regulation) improve outcomes, particularly in those who report strong food cravings.  Understanding the powerful biology underpinning cravings, improving awareness and mindfulness of cravings, and having support in developing coping skills to help manage cravings is important.

From a weight management medication perspective, naltrexone/bupropion (trade name Contrave) is a weight management medication that reduces both appetite and cravings (read on in our Canadian Obesity Guidelines chapter on weight management medications).  Semaglutide 2.4mg weekly (trade name Wegovy) also reduces appetite and cravings.

Bariatric surgery can also work to reduce both appetite and cravings, with some data suggesting cravings reduction is greater with gastric bypass surgery than with sleeve gastrectomy.

BOTTOM LINE: For many people who are struggling with elevated weight, craving can be a formidable force that is difficult to contend with. Understanding the powerful (and highly variable) genetics and the biology underpinning cravings, and having support from the Three Pillars of Weight Management, are important components of a successful weight management strategy!

Disclaimer:  I receive honoraria as a continuing medical education speaker and consultant from the makers of naltrexone/bupropion (Bausch) and semaglutide (Novo Nordisk).

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